Tag: Louise Esola

Insurance legislators reintroduce physician dispensing model law
Welfare

Insurance legislators reintroduce physician dispensing model law

Reprints Louise Esola The National Council of Insurance Legislators’ latest model law on pharmaceutical reimbursement in workers compensation is a reintroduction of a 2013 model law that represents a new push to help educate more state lawmakers on the importance of reining in drug costs for injured workers, according to the organization’s leader.
The model law aims to re-establish clear guidelines for doctors when it comes to reimbursement and distribution of drugs to help reduce workers compensation insurance costs, according to a draft of the Workers Compensation Pharmaceutical Reimbursement Rates Model Act included in NCOIL’s spring meeting agenda, set for March 2-4 in Atlanta.
It zeros in on physician dispensing and drug compounding in workers compensation — issues states are grappling with, NCOIL CEO Tom Considine told Business Insurance from his office in Manasquan, New Jersey.
“We believe this is a hidden accelerator in health costs,” he said, echoing the sentiments of many in comp circles who believe physicians dispensing drugs can raise costs significantly.
1846, which introduced physician prescribing rules, during the 2013-14 session of the Pennsylvania House of Representatives.
She could not be reached for comment.
NCOIL’s model law aims to get more states on board with change, Mr. Considine said, adding that NCOIL is now in the process of tallying which states enacted laws based on the organization’s 2013 adopted model law on the practice of physician dispensing.
Twenty-two states have limits on physician dispensing practices, according to data gathered in early 2017 by Matrix Healthcare Services Inc., then doing business as MyMatrixx and recently acquired by Express Scripts Holding Co.
A spokeswoman for the Washington-based National Association of Insurance Commissioners told Business Insurance that model laws can be effective in inspiring change.
The act also limits physician-distributed drugs to no more than a first fill within seven days from the date of injury, according to the draft.

S.D. bill aims to prevent lawsuits against comp insurers, employers
Welfare

S.D. bill aims to prevent lawsuits against comp insurers, employers

Reprints Louise Esola Lawmakers in South Dakota are slated Tuesday to hear about proposed legislation that would prevent injured workers from suing their employers, workers compensation insurers and third-party administrators on bad faith claims.
S.B.
145, sponsored by a total of 21 state senators and representatives, will leave bad faith claims up to the state’s Department of Labor and Regulation, which oversees the state’s workers compensation program, and would ensure that an employee receives that which is due.
Currently, parties involved in workers comp claims can be sued in civil court if an employee finds that he or she has been treated unfairly.
The department, if it finds favor in the employee’s claim, can “allow the employee a reasonable sum for attorney’s fees to be recovered and collected as part of the costs following a separate hearing of record,” according to a draft of the legislation.
“No person may bring or maintain a cause of action in relation to workers’ compensation benefits sounding in tort or in contract against any employer, employer who is self insured, a risk sharing pool, a third-party administrator, or any insurance company, including any reciprocal or interinsurance exchange, based on a wrongful act, omission, wrongful denial or any claim for refusal to investigate a claim or pay a loss that was considered vexatious, without reasonable cause, or in bad faith,” the draft states.

Termination of benefits affirmed in case related to bomb threat
Welfare

Termination of benefits affirmed in case related to bomb threat

Reprints Louise Esola A customer service operator in Pennsylvania who claimed she suffered from post-traumatic stress disorder after being forced to stay at her desk to answer phones during repeated bomb threats to her office lost her appeal with the Pennsylvania Workers’ Compensation Appeal Board for a full continuation of workers comp benefits after her employer’s doctor testified that a panic disorder and depression existed before the incident, according to the ruling issued Wednesday.
The employee was working for Duquesne Light Co. when in 1996 someone began calling in bomb threats, according to court records, which chronicle the series of events: “In September 1996, there was a bomb threat in the workplace.
She was afraid to continue working in the building where the bomb threats occurred.
Claimant later returned to work for Employer in a janitorial position in a different building.
However, she left that job because of physical problems unrelated to the 1996 bomb threats.” A year later, the employee filed a claim seeking workers compensation medical benefits related to the 1996 bomb threats.
In 1999, a judge found she sustained three separate mental injuries because of abnormal working conditions created by the 1996 bomb threats: post-traumatic stress disorder; major depressive disorder; and panic disorder.
In August 2011, her employer filed a petition to terminate her benefits, alleging Ms. Vassar-Watts had fully recovered from her work-related injuries, and including in their petition expert medical testimony that found her continued suffering was found to be unrelated to the bomb threats, according to records.
A three-judge judge with the Workers Compensation Appeal Board on Wednesday affirmed the termination of her medical benefits related to treatment of PTSD and major depressive disorder but reversed the order to terminate “medical benefits related to ongoing treatment, if any, of panic disorder,” according to the ruling.
The case is No.
2017 in the Commonwealth Court of Pennsylvania.